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British Medical Journal
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The BMJ aims to publish rigorous, accessible and entertaining material that
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Acyclovir given as prophylaxis against oral ulcers in acute myeloid leukaemia: randomised, double blind, placebo controlled trial
BMJ 1995;310:1169-1172 (6 May)
by Olav J Bergmann, senior registrar and dentist,Svend Ellermann-Eriksen, assistant professor, Soren C Mogensen, professor, Jorgen Ellegaard, professor
Objectives:
To evaluate (a) the prophylactic effect of the antiherpetic drug acyclovir on oral ulcers
in patients with acute myeloid leukaemia receiving remission induction chemotherapy
and thus (b), indirectly,
the role of herpes simplex virus in the aetiology of these ulcers.
Results:
The two populations were comparable in age, sex, type of antineoplastic treatment,
and history of herpes labialis. Acute oral infections occurred in 25 of the acyclovir
treated patients and 36 of the placebo treated patients (relative risk 0.69
(95% confidence interval 0.55 to 0.87)). This difference was due to a reduction
in the incidence of herpes labialis (one case versus eight cases; relative risk
0.13 (0.02 to 0.95)), intraoral ulcers excluding the soft palate
(one case versus 13 cases; relative risk 0.08 (0.01 to 0.56)),
and acute necrotising ulcerative gingivitis
(one case versus eight cases; relative risk 0.13 (0.02 to 0.95)).
However, ulcers on the soft palate were diagnosed with similar frequency in the two groups.
Isolation of herpes simplex virus type 1 in saliva was reduced from 15 cases in the placebo
group to one case in the acyclovir group (relative risk 0.07 (0.01 to 0.48)).
Conclusion:
Intraoral ulcers excluding the soft palate are most often due to infection with herpes
simplex virus, whereas ulcers on the soft palate have a non-herpetic aetiology.
The findings suggest that acute necrotising ulcerative gingivitis may also be due
to herpes simplex virus. Prophylaxis with acyclovir should be considered
for patients with acute myeloid leukaemia during remission induction therapy.
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